Prognostic impact of SPECT-MPI after renal transplantation

While renal transplantation is increasingly performed for end-stage renal disease, there is a paucity of data on cardiac screening and prognostication post-transplant. we determined the prognostic value of spect-mpi in a cohort who underwent renal transplantation. among 4933 renal transplant recipients identified from the canadian organ replacement register, we examined outcomes of patients who underwent spect-mpi in ontario, canada. we determined morbidity and mortality using hospitalization and vital statistics registries, according to spect-mpi findings. we studied 282 renal transplant recipients (median age 46 years [25th, 75th percentile 37, 58]) with detailed spect-mpi results available, followed for a median of 5.7 (3.3, 7.7) years. among those undergoing spect-mpi (66% pharmacologic stress), 41% had an abnormal summed stress score (sss > 0) and 31% demonstrated abnormal summed difference score (sds > 0). rates of cardiovascular death were 0.4 per 100 person-years among those with normal stress perfusion (sss = 0) and 0.4 per 100 person-years with sds = 0. after adjusting for age, sex, prior myocardial infarction (mi), and cardiac risk factors, an sss ≥ 4 conferred increased risk of cardiovascular death or cardiovascular hospitalization with adjusted hazard ratios of 2.52 (95% ci 1.41, 4.52, p = .002) for sss 4-6 and 2.61 (95% ci 1.52, 4.49, p < .001) for sss ≥ 7. sds was a significant predictor of cardiovascular death or hospitalization, with adjusted hazard ratios of 2.96 (95% ci 1.72, 5.09, p < .001) for sds 4-6 and 3.26 (95% ci 1.64, 6.50, p < .001) for sds ≥ 7. among renal transplant recipients, spect-mpi predicted risk of cardiovascular death and cardiovascular hospitalization events.